In a recent issue of the ARCHIVES, Richardson et al1 presented the cost-saving data of the use of an algorithm for staging small-cell lung cancer.1 Among 20 160 permutations of a sequence of conventional staging procedures, they have selected the least expensive one, allowing to stop further detection of metastases as soon as an involved site has been identified. Using such a sequential method, only 60% of the 451 patients who were studied would need to undergo expensive staging procedures such as computed tomography and nucleide bone scans, as well as bone marrow aspiration and biopsy. The proposed decisional analysis allows a $1418 savings per patient, which is one third of the calculated cost of a complete staging.
Using the same type of analysis with the same decision and judgment criterion, we have previously published similar results2 in this disease. We have described a three-step staging system